| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,412 |
1,390 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,293 |
1,279 |
$36K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
292 |
129 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,549 |
1,523 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
266 |
168 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
414 |
392 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
151 |
101 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
238 |
$10K |
| D0330 |
Panoramic radiographic image |
184 |
184 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
129 |
73 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
483 |
318 |
$7K |
| D0272 |
Bitewings - two radiographic images |
542 |
525 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
449 |
439 |
$4K |
| D1110 |
Prophylaxis - adult |
127 |
127 |
$4K |
| D1351 |
Sealant - per tooth |
144 |
55 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
73 |
$2K |
| D0274 |
Bitewings - four radiographic images |
90 |
90 |
$2K |